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Hospital Closings Likely to Increase

Map by University of North Carolina researchers shows states at highest risk
of rural hospital closures. The trend has been accelerating since 2010.

Hospitals located in rural areas have been closing their doors more frequently and at higher rates than urban facilities in recent years — and a pattern of increasing financial distress suggests that more are likely to falter, experts said in a recent web conference.

The small hospitals are often the only health care available in rural counties, and those most affected by hospital closings tend to be poor, minorities and elderly patients with chronic health conditions.

"The hotspot for closures and financial distress continues to be the South – particularly Florida, Alabama, Tennessee, Arkansas and Virginia … as well as Texas," Pink told a Sept. 21 webcast audience. "A lot of states in the Midwest have no hospitals that are rural and at high risk of financial distress."

Further, he said, many of the closures in recent years affected Critical Access Hospitals, a designation by the Centers for Medicare and Medicaid Services for facilities that provide essential services in especially isolated communities. And most shut down amid financial woes tied to upkeep costs for things like leaking roofs, antiquated power supplies and aging clinical equipment.

The Federal Office of Rural Health Policy housed at HRSA has a number of programs designed to help these smaller hospitals improve quality and track their viability. Currently, 96 percent of the 1,340 access facilities in the U.S. are reporting rural-relevant quality measures.

UNC's Pink and other researchers reviewed the fiscal health of more than 2,300 rural hospitals and published their conclusions last October. Though closings remain a "relatively rare event, they get a lot of media attention," he said, because the consequences for local patients and local economies can be so far-reaching – with the sick and injured often having to travel 30 miles or more to find care (at right).

Hospitals at high risk for financial trouble – estimated today to be nine percent of those in rural America — often serve those who are unemployed, lack transportation or suffer from mobility limitations due to conditions like obesity, diabetes and tobacco use.

"These more vulnerable populations," Pink said, "are at increased risk of losing access to some types of health care, exacerbation of health disparities and loss of hospital and other types of local employment."